[ACE inhibition: mechanisms of cardioprotection in chronic heart failure]

In the treatment of heart failure ACE inhibitors gained a unique position because of their beneficial effect on prognosis. The most likely explanation is their influence on factors that determine progression of the disease. These are: progressive deterioration of central hemodynamics, impairment of coronary perfusion, further activation of vasopressor systems, imbalance of sodium and water homeostasis and occurrence of malignant arrhythmias. ACE inhibitors have been shown to modulate these factors in a positive manner. In addition, they may also act by modulating factors, which may exert harmful effects on cardiac function in long term. These are: prevention and regression of the hypertrophy of the left ventricle as well as the media of resistance vessels, prevention of restenosis following PTCA, prevention of cyclosporin-induced premature coronary artery sclerosis, and correction of an impaired glucose metabolism. Whereas the positive effects of ACE inhibitors in the treatment of heart failure are well documented, their value for preventing heart failure has not been established, yet.